Objective:To evaluate the role of percutaneous endoscopic gastrostomy/jejunostomy(PEG/PEJ) in critical patients. Methods:Percutaneous endoscopic gastrostomy/jejunostomy procedures were performed in 25 critical patients. Indication, procedure-related complication,technical success and clinical outcome were reviewed. Results:The technical success was 100% and there were no serious complications. In 4 patients(16%),local cleansing, drainage were used for the infection of PEG site. PEJ tube dysfunction occurred in 3 patients(12%). Conclusion:PEG /PEJ is a safe,minimal invasive,and effective procedure for enteral nutrition in critical patients.

Objective:To evaluate the effect and the significance of combined treatment for severe acute pancreatitis in ICU.Methods:96 cases of severe acute pancreatitis treated in ICU of the hospital where the authors worked from Jan.1996 to Jun.2004 were analyzed retrospectively.Results:GroupⅠwere treated with routine methods.14 patients died and the mortality was 31.8%(14/44).Group Ⅱwere treated with routine methods combined with continuous renal replacement therapy(CRRT).5 patients were treated with CRRT twice.26 patients were treated with emergent endoscopic retrograde cholangiopancreatography(ERCP),endoscopic sphincterotomy(EST) and endoscopic naso-bile drainage(ENBD).32 patients were treated with the mechanical ventilation.46 patients were cured and 6 patients died. The mortality was 11.5%(6/52).Conclusion:The combined treatment in ICU can increase the curative effect of the severe acute pancreatitis.

Objective: To evaluate the effect and the significance of combined treatment for acute severe pancreatitis complicated with acute respiratory distress syndrome(ARDS) in ICU.Methods: 71 cases of severe acute pancreatitis with ARDS treated in ICU of the hospital where the authors worked from Jan.1996 to Apr.2005 were analyzed retrospectively.Results: GroupⅠwere treated with routine methods and the mechanical ventilation.14 patients died,and the mortality was 48.3%(14/29).Group Ⅱwere treated with routine methods and the mechanical ventilation.All patients were treated with continuous renal replacement therapy(CRRT),of whom 7 patients were treated with CRRT twice.22 patients were treated with emergent endoscopic retrograde cholangiopancreatography(ERCP),endoscopic sphincterotomy(EST) and endoscopic naso-bile drainage(ENBD).33 patients were cured and 9 patients died.The mortality was 21.4%(9/42).Conclusion: The combined treatment in ICU can increase the curative effect of the severe acute pancreatitis complicated with ARDS.

Fecal microbiota transplantation (FMT) has become a key treatment for Clostridium difficile infection (CDI).The Chinese fecal microbiota bank rescue plan is a non-profit central platform for the treatment of refractory CDI using FMT.This article reviewed and analyzed the principle,protocol and risk management of the Chinese fecal microbiota bank rescue plan.

0.05). The absolute counts of RhD(+) cell of 2 patients at 3 different times were 0.124?10 12 /L, 0.245 ?10 12 /L and 0.517?10 12 /L respectively.Conclusion FCM can be used to detect RhD antigen and perform RhD(+) cell counts in patients with RhD(-) who received incompatible blood.

Objective To evaluate the value of thoracotomy through small right subaxillary oblique incision for pediatric ventricular septal defect(VSD). Methods From November 2001 to December 2008,1539 children with VSD underwent thoracotomy through small right subaxillary oblique incision in our hospital.At the fourth intercostal space between the anterior and middle axillary lines,a straight or oblique incision was made,then along the inferior edge of the fourth rib the chest was opened,and the right edge of the pericardium was fixed at the thoracic retractor.Afterwards,off-pump circulation was established and minimally invasive cardiac surgery was carried out.Results The procedure was completed successfully in all the 1539 patients.The cross-clamp time was(22.8?11.4) min(11 to 48 min),and CPB time was(33.0?14.9) min(27 to 64 min).Two patients(0.13%,2/1539) died in 24 hours after the operation.One of them died of severe allergic reaction to protamine.And the other died of severe low cardiac output in 4 hours after the surgery,because of an injury to the left coronary artery.In this series,the postoperative complications included incisional infection in 3 cases,atelectasis in 9,perfusion lung in 5,low cardiac output in 5,infectious endocarditis in 3 and acute renal failure in 4.These 29 cases were discharged after the complications being cured.Follow-up was available in 1446 cases for(47.0?11.2) months(range,6~91 months).During the period,small residual shunts in the VSD were detected in 5 cases,and other cases showed no abnormalities.Conclusions Thoracotomy through small right subaxillary oblique incision is minimally invasive,safe and effective for pediatric VSD.

Objective To evaluate left ventricular function before and after percutaneous balloon mitral valvuloplasty (PBMV) by echocardiography. Methods Left ventricular function of 80 patients who underwent PBMV were estimated by echocardiography before and after operation. Results Left ventricular end-diastolic volume (EDV), cardiac output(CO), systolic volume (SV)and ejection fraction (EF) significantly increased 1 week after PBMV, but Left ventricular end-systolic volume (ESV) had no change. EF improved as mitral valve area(MVA)increased, But it had no change while the pressure gradient across the mitral valve(PG)reduced. Left ventricular function had no further improvement 3 months after PBMV. Conclusion Left ventricular function of most of the patients was improved as EDV increased after PBMV, especially early stage after PBMV. MVA was the most important factor which influenced the left ventricular function. There was no significant correlation between EF and the PG reduction after PBMV.

In order to verify the effects of postburn fluid infusion on the tissue water content,extravascular water volume,residual blood water volume,and total water volume of the major organs were measured in dogs inflicted with 50% TBSA third degree burns and the dogs received no fluid infusion,immediate infusion or delayed infusion respectively.It was found that the water contents of most of the canine organs,no matter they received fluid infusion or not,were higher than those of the control.The increase was especially marked in the extravascular water volume and less marked in the residual blood water volume,which suggests that the increase of water content of most of the organs of the burned animals results mainly from tissue edema rather than congestion and/or stasis of blood.

Objective To observe and compare the operation ,short-term therapeutic effect and long-term therapeutic effect be-tween painless gastrostomy under endoscopy and nasal-jejunal catheterization as well as to explore their clinical feasibility and clini-cal application .Methods 81 cases of patients with severe acute pancreatitis in the hospital ICU from May 2012 to September 2013 , were divided into gastrostomy jejunostomy group(43 cases)and nasojejunal feeding group(38 cases) .The operation time ,gastroin-testinal nutrition tube inner curvature ,removal rateetc were observed to calculate the success rate .Contrast ratio ,plugging rate and catheter related infection rate and several indexes were observed to evaluate the therapeutic effect of two groups of short-term infec-tion ofincision .long-term calculation of two groups with tube ,comfort score and nutritional indexes to evaluate the therapeutic effect index .Results The operation time ,the digestive tract inside area rate ,nutrition tube removal ,catheter related pulmonary infection rate ,average indwelling catheter time ,comfort ,nutrition index of the two groups had statistically significant (P<0 .05) ,plugging rate ,wound infection rate had no statistically significant (P>0 .05) .Conclusion With fewer complications and longer tube time , painless gastrostomy under endoscopy is safe ,simple and feasible ,which is easily accepted by patients .

AIM:To study the effects of lipopolysaccharide(LPS), interleukin-6(IL-6)and tumor necrosis factor ? (TNF?) on tissue factor(TF) expression of astrocytes. METHODS:Astrocytes were identified with anti-glial fibrillary acidic protein antibody. The TF activity of cell lysate was measured with one stage clotting assay. RESULTS:TF activity of astrocytes of LPS,IL-6,TNF? groups were obviously higher than that of the control group( P